Valacyclovir and Prednisolone Treatment for Bell's Palsy

Hato, Naohito; Yamada, Hiroyuki; Kohno, Hiromasa; Matsumoto, Shuichi; Honda, Nobumitsu; Gyo, Kiyofumi; Fukuda, Satoshi; Furuta, Yasushi; Ohtani, Fumio; Aizawa, Hiroshi; Aoyagi, Masaru; Inamura, Hiroo; Nakashima, Tsutomu; Nakata, Seiichi; Murakami, Shingo; Kiguchi, Jun; Yamano, Koji; Takeda, Taizo; Hamada, Masashi; Yamakawa, Kazuhiro

doi:10.1097/01.mao.0000265190.29969.12

Cited by 207 publications

(58 citation statements)

References 27 publications

(19 reference statements)

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“…It did not show any benefit of acyclovir, in contrast to a recent randomised trial of valcyclovir and prednisolone that suggested that antiviral treatment is effective 4. However, the results of the latter study need to be interpreted with caution because of several methodological flaws, including lack of assessor blinding and low follow-up rate.…”

contrasting

confidence: 60%

Early treatment with prednisolone, but not acyclovir, was effective in Bell's palsy

Oczkowski

2008

Evidence-Based Medicine

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contrasting

confidence: 60%

Early treatment with prednisolone, but not acyclovir, was effective in Bell's palsy

Oczkowski

2008

Evidence-Based Medicine

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“…Among these 39 studies, 1 studies were duplicates, 13 studies were ineligible, leaving 12 studies to review. Six studies were excluded; two were in Spanish, one was in German, and 3 were subsets or duplicated reports, leaving six studies[8-10,12,13,25] with a total of 1805 patients for analysis. Characteristics of the 6 included studies are described in table 1.…”

Section: Resultsmentioning

confidence: 99%

“…Characteristics of the 6 included studies are described in table 1. Five studies[8-10,12,13] compared recovery rates of AVT plus corticosteroid with corticosteroid alone or placebo; the remaining study directly compared the recovery rate of AVT against corticosteroid[25]. Two studies were based on factorial design[9,12] and the others were parallel randomized control trials.…”

Section: Resultsmentioning

confidence: 99%

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Corticosteroid and antiviral therapy for Bell's palsy: A network meta-analysis

et al. 2011

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BackgroundPrevious meta-analyses of treatments for Bell's palsy are still inconclusive due to different comparators, insufficient data, and lack of power. We therefore conducted a network meta-analysis combining direct and indirect comparisons for assessing efficacy of steroids and antiviral treatment (AVT) at 3 and 6 months.MethodsWe searched Medline and EMBASE until September 2010 using PubMed and Elsviere search engines. A network meta-analysis was performed to assess disease recovery using a mixed effects hierarchical model. Goodness of fit of the model was assessed, and the pooled odds ratio (OR) and 95% confidence interval (CI) were estimated.ResultsSix studies (total n = 1805)were eligible and contributed to the network meta-analysis. The pooled ORs for resolution at 3 months were 1.24 (95% CI: 0.79 - 1.94) for Acyclovir plus Prednisolone and 1.02 (95% CI: 0.73 - 1.42) for Valacyclovir plus Prednisolone, versus Prednisolone alone. Either Acyclovir or Valacyclovir singly had significantly lower efficacy than Prednisolone alone, i.e., ORs were 0·44 (95% CI: 0·28 - 0·68) and 0·60 (95% CI: 0·42 - 0·87), respectively. Neither of the antiviral agents was significantly different compared with placebo, with a pooled OR of 1·25 (95% CI: 0·78 - 1·98) for Acyclovir and 0·91 (95% CI: 0·63 - 1·31) for Valacyclovir. Overall, Prednisolone-based treatment increased the chance of recovery 2-fold (95% CI: 1·55 - 2·42) compared to non-Prednisolone-based treatment. To gain 1 extra recovery, 6 and 26 patients need to be treated with Acyclovir and prednisolone compared to placebo and prednisolone alone, respectively.ConclusionsOur evidence suggests that the current practice of treating Bell's palsy with AVT plus corticosteroid may lead to slightly higher recovery rates compared to treating with prednisone alone but this does not quite reach statistical significance; prednisone remains the best evidence-based treatment.

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“…11 There is currently no evidence to support the use of either antiviral drug on its own, 12,13 and there is uncertainty regarding the benefit of adding them to corticosteroids.…”

Section: Antiviral Drugsmentioning

confidence: 99%